TOPLINE: Ionized hypocalcemia is seen in at least one in six pediatric patients with major trauma admitted to the emergency department (ED).

METHODOLOGY: 

• Researchers performed a meta-analysis of three studies to assess the incidence of ionized hypocalcemia in pediatric patients with major trauma (age, < 18 years; with an Injury Severity Score > 15 or requiring trauma team activation) admitted to the ED between 2010 and 2021.
• Ionized calcium (iCa) concentration on admission to the ED was used to identify the presence of ionized hypocalcemia (iCa < 1.16 mmol/L) or normocalcemia (iCa ≥ 1.16 mmol/L).
• The primary outcome was the incidence of admission ionized hypocalcemia.
• The secondary outcomes were the associations of admission ionized hypocalcemia with mortality, need for transfusion, hospital or pediatric intensive care unit length of stay (LOS), and pH differences between hypocalcemic and normocalcemic patients.

TAKEAWAY: 

• Overall, 15.8% patients had admission ionized hypocalcemia, with admission ionized hypocalcemia defined as iCa concentrations ranging from < 1.00 mmol/L to < 1.16 mmol/L.
• Patients with ionized hypocalcemia required more blood transfusions than those with normocalcemia (P <.001).
• There was no significant difference in mortality, hospital or PICU LOS, and pH between patients with hypocalcemia and those with normocalcemia.

IN PRACTICE:

“Admission iHypoCa [ionized hypocalcemia] was present in at least one in six pediatric major trauma patients and may be associated with hemodynamic instability and increased blood transfusion requirements, ” the authors concluded.

SOURCE: 

The investigation, led by Owen Hibberd, Emergency and Urgent Care Research in Cambridge (EURECA), PACE Section, Department of Medicine, Cambridge University, Cambridge, United Kingdom, was published online in PLoS One. 

LIMITATIONS: 

The study was limited by the small number of available studies, all of which had a retrospective single-center design. Different definitions of ionized hypocalcemia could have underestimated its incidence and implications. The study lacked the ability to detect differences in mortality since only inpatient mortality was reported. 

DISCLOSURES: 

The study did not receive any specific funding. The authors declared that they had no conflicts of interest.